MEME KORUYUCU CERRAHİ SONRASI LOKAL NÜKS

Yıl 2016, Cilt: 49 Sayı: 1, 46 - 54, 01.03.2016

G Selçuk Özbalcı Aysu B. Özbalcı Salih Tuncal

Öz

Meme koruyucu cerrahi MKC , tümörle birlikte çevresinden bir miktar sağlam meme dokusunun çıkartılması ve koltuk altı lenf bezlerinin diseksiyonu işlemlerini içerir. Kalan meme dokusuna radyoterapi RT verilmesi de bu tedavinin bir parçası olarak uygulanmalıdır. MKC erken evre meme kanserinin tedavisinde sıklıkla tercih edilen bir seçenektir. MKC ile memenin tümüyle alınması arasında hastanın yaşam süresi bakımından hiçbir fark yoktur. MKC’nin mastektomiye M olan üstünlüğü, memenin büyük bir bölümünün korunmasını sağladığı için elde edilen daha iyi kozmetik ve psikolojik sonuçtur. Dezavantajı ise geriye kalan meme dokusunda tümörün tekrar etme riskinin biraz daha yüksek olmasıdır. Nüks gelişimine etki eden; tümöre, hastaya ve tedaviye bağlı çeşitli faktörler vardır. Bu derlemede MKC sonrası lokal nüks gelişimine etki eden risk faktörleri, MKC sonrası takip ve nükse yönelik tedavi seçenekleri gözden geçirildi

Anahtar Kelimeler

Meme kanseri, lokal nüks, meme koruyucu cerrahi

LOCAL RECURRENCE AFTER BREAST CONSERVATIVE SURGERY

Öz

Breast conservative surgery BCS is defined as the excision of tumor with surrounding healthy breast tissue and dissection of axillary lymph nodes. Radiotherapy RT to the remaining breast tissue must be given as a part of the treatment protocol. BCS is a commonly used treatment in the early stages of breast cancer. There is no significant difference between the survival rates of patients who had mastectomy M and BCS. The advantage of BCS over M is better cosmetic and psychological results. The main disadvantage of BCS is higher risk of recurrence in the remaining breast tissue. There are various factors which contribute to local recurrence related to the tumor, patient and treatment. In this review, risk factors that contribute to local recurrence, follow up after BCS and treatment options for recurrence were analyzed

Anahtar Kelimeler

Breast cancer, local recurrence, breast conservative surgery

Kaynakça

• 1)Robinson J.O. Treatment of breast cancer through the ages. Am J Surg. 1986; 151: 317-33.
• 2)Meric F, Robinson EK, Hunt KK. Noninvasive Breast Cancer. In: Feig BW, Berger DH, Fuhrman GM, eds. The M.D. Anderson Surgical Oncology Handbook. 3rd ed. Houston,Teksas: Lippincott Williams&Wilkins, 2003: 1-13.
• 3)Onat D. Operable Meme Kanseri Tedavisi. Sayek İ, editör. Temel Cerrahi. 2. Baskı. Ankara: Güneş Kitabevi. 1996: 873-80.
• 4)Tebra S, Bouguizene S, Bibi M, Boussen H, Khairi H, Bouaouina N. Conserving surgery for breast cancer Tunis Med. 2010; 88: 453-8.
• 5)Pleijhuis RG, Graafland M, de Vries J, Bart J, de Jong JS, van Dam GM. Obtaining adequate surgical margins in breast-conserving therapy for patients with early-stage breast cancer: current modalities and future directions. Ann Surg Oncol. 2009; 16: 2717–30.
• 6)Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E Twenty year follow up of a randomised study comparing breast-conserving surgery with radical mastectomy for early breast canser. N Engl J Med. 2002; 347: 1227-32.
• 7)Newman LA, Washington TA. New Trends in Breast Conservation Therapy. Surg Clin North Am. 2003; 83: 841-83.
• 8)Müslümanoğlu M. Meme Koruyucu Cerrahi Sonrası Görülen Lokal Nükslerde Cerrahi Yaklaşım. Topuz E, Aydıner A, Dinçer M, editörler. Meme Kanseri. 1. Baskı. İstanbul: Nobel Tıp Kitapevleri. 2003: 471-5.
• 9)Haffty BG, Carter D, Flynn SD, Fischer DB, Brash DE, Simons J, Ziegler AM, Fischer JJ. Local recurrence versus new primary: Clinical analyses of 82 breast relapses and potential aplications for genetic finger printing. İnt J Radiat Oncol Biol Phys. 1993; 27: 575-83.
• 10)Francis M, Cakir B, Ung O, Gebski V, Boyages J. Prognosis after breast recurrence following conservative surgery and radiotherapy in patients with node-negative breast canser. Br J Surg.1999; 86: 1556-62.
• 11)van Dongen JA, Bartelink H, Fentiman IS, Lerut T, Mignolet F, Olthuis G, van der Schueren E, Sylvester R, Tong D, Winter J. Factors influencing lokal relapse and survival and results of salvage treatment after breast-conserving therapy in operable breast canser. EORCT trial 10801, Breast conservation compared with mastectomy in TNM stage I and II breast canser. Eur j Canser.1992; 28A: 801-5.
• 12)van Tienhoven G, Voogd AC, Peterse JL, Nielsen M, Andersen KW, Mignolet F, Sylvester R, Fentiman IS, van der Schueren E, van Zijl K, Blichert-Toft M, Bartelink H, van Dongen JA. Prognosis after threatment for loco-regional recurrence after mastectomi or breast conserving therapy in two randomised trials(EORTC 10801 and DBCG-82TM) EORTC Breast Cancer Cooperative Group and the Danish Breast Cancer Cooperative Group.Eur J Cancer. 1999; 35: 32-8.
• 13)Abner AL, Recht A, Eberlein T, Come S, Shulman L, Hayes D, Connolly JL, Schnitt SJ, Silver B, Harris JR. Prognosis following salvage mastectomy for recurrence in the breast after conservative surgery and radiation therapy for early-stage breast canser. J Clin Oncol. 1993; 11: 44-8.
• 14)Voogd AC, van Tienhoven G, Peterse HL, Crommelin MA, Rutgers EJ, van de Velde CJ, van Geel BN, Slot A, Rodrigus PT, Jobsen JJ, von Meyenfeldt MF, Coebergh JW. Local recurrence after breast conservation therapy for early stage breast carcinoma: detection, treatment and outcome in 266 patients. Dutch Study Group on Local Recürrence after Breast Conservation (BORST). Cancer. 1999; 85: 437-46.
• 15)Fisher B,Anderson S,Fisher ER,Redmond C,Wickerham DL,Wolmark N. Significance of ipsilateral breast tumour recurrence after lumpectomy. Lancet.1991; 338: 327-31.
• 16)Nottage MK, Kopciuk KA, Tzontcheva A, Andrulis IL, Bull SB, Blackstein ME. Analysis of incidence and prognostic factors for ipsilateral breast tumour recurrence and its impact on disease-specific survival of women with node-negative breast cancer: a prospective cohort study. Breast Cancer Res. 2006; 8: 44.
• 17)Ryoo MC, Kagan AR, Wollin M, Tomé MA, Tedeschi MA, Rao AR, Hintz BL, Kuruvilla AM, Nussbaum H, Streeter OE Jr. Prognostic factors for recurrence and cosmesis in 393 patients after radiation therapy for early mammory carsinoma. Radiology. 1989; 172: 555-9.
• 18)Cajucom CC, Tsangaris TN, Nemoto T, Driscoll D, Penetrante RB, Holyoke ED.. Results of salvage mastektomi for local recürrence after breast coserving surgery without radiation therapy. Cancer. 1993; 71: 1774-9.
• 19)Osteen RT. Risk factors and managements of local recurrence following breast conservation surgery. World J Surg.1994; 18: 76-80.
• 20)Fourquet A, Campana F, Zafrani B, Mosseri V, Vielh P, Durand JC, Vilcoq JR..Prognostic factors of breast recurrence in the conservative management of early breast canser: A 25 year follow-up. Int J Radiat Oncol Biol Phys. 1989; 17: 719-25.
• 21)Noguchi S, Koyama H, Kasugai T, Tsukuma H, Tsuji N, Tsuda H, Akiyama F, Motomura K, Inaji H. A case-control study on risk factors for local recurrences or distant metastases in breast cancer patients treated with breast conserving surgery. Oncology. 1997; 54: 468-74.
• 22)İğci A. Erken Evre Meme Kanserinde Cerrahi Tedavi. T Klin J Surgery. 2002;7: 67-77.
• 23)Recht A, Hayes DF, Everlein TJ, Sadowsky NL. Local-regional recurrence after mastectomy or breast conserving therapy. In: Harris JR, Lippman ME, Morrow M, Hellman S, editors. Diseases of the Breast. 1st ed. Philadelphia: Lippincott-Raven Publishers. 1996: 649-668.
• 24)Deantonio L, Gambaro G, Beldì D, Masini L, Tunesi S, Magnani C, Krengli M. Hypofractionated radiotherapy after conservative surgery for breast cancer: analysis of acute and late toxicity. Radiat Oncol. 2010; 23: 112.
• 25)Lovrics PJ, Cornacchi SD, Farrokhyar F, Garnett A, Chen V, Franic S, Simunovic M.. Technical factors, surgeon case volume and positive margin rates after breast conservation surgery for early-stage breast cancer. Can J Chir. 2010; 53: 305-12.
• 26)Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N.. Twenty- year follow-up of a randomised trial comparing total mastectomy, lumpectomy and lumpectomy plus irradiation for the treatment of invazive breast canser. N Engl. J.Med, 2002; 347: 1233-41.
• 27)Aydıner A, Topuz E. Lokorejyonel rekürren meme kanserinde sistemik ilaç tedavisi. Topuz E, Aydıner E, Dinçer M, editörler. Meme Kanseri. 1. Baskı. İstanbul: Nobel Tıp Kitapevleri. 2003: 476-84.
• 28)Stotter A, Kroll S, McNeese M, Holmes F, Oswald MJ, Romsdahl M. Salvage treatment for loco-regional recurrence following breast conservation therpy for early breast cancer. Eur J Surg Oncol. 1991; 17: 231-6.
• 29)Buchholz TA, Tucker SL, Erwin J, Mathur D, Strom EA, McNeese MD, Hortobagyi GN, Cristofanilli M, Esteva FJ, Newman L, Singletary SE, Buzdar AU, Hunt KK.. Impact of sistemic treatment on local control for patients with lymph node-negative breast cancer treated with breast-conservation therapy. J Clin Oncol. 2001; 19: 2240-6.
• 30)Recht A., SadowskyN.L., Cady B. Clinical problems in follow-up of patients after conservative surgery and radiotherapy. Surg Clin North Am. 1990; 70: 1179-86.
• 31)Stigers KB, King JG, Davey DD, Stelling CB Abnormalities of the breast caused by biopsy: Spectrum of mammographic findings. AJR Am J Roentgenol. 1991; 156: 287-91.
• 32)Sadowsky NL, Semine A, Harris JR. Breast imaging. A critical aspect of breast conserving treatment. Cancer.1990; 65: 2113-8.
• 33)Hassell PR, Olivotto IA, Mueller HA, Kingston GW, Basco VE.Early breast cancer: detection of recurrence after conservative surgery and radiation therapy. Radiology. 1990; 176: 731-5.
• 34)Brenner RJ, Pfaff JM. Mammographic features after conservation therapy for malignant breast disease: serial findings standardized by regression analysis. AJR Am J Roentgenol. 1996; 167: 171-8.
• 35)Markopoulos C., Gazet J.C. Paget’s disease of nipple occuring after conservative management of early breast cancer. Eur J Surg Oncol. 1988; 14: 77-8.
• 36)Orford JE, Ingram DM, Kaard AO, Sheiner HJ.. Scar formation after breast-conserving surgery for cancer. Sir Charles Gairdner Hospital Breast Cancer Group. Br. J Surg. 1993; 80: 1003-4.
• 37)Mitnick J, Roses DF, Harris MN. Differantiation of postsurgical changes from carcinoma of the breast. Surg Gynecol Obstet.1988; 166: 549-50.
• 38)Mendelson E.B. Radiation changes in the breast. Semin Roentgenol. 1993; 28: 344-62.
• 39)Dao TH, Rahmouni A, Campana F, Laurent M, Asselain B, Fourquet A. Tumor recurrence versus fibrosis in the irradiated breast: Differentiation with dynamic gadolinium-enhanced MR imaging. Radiology. 1993; 187: 751-5.
• 40)Mumtaz H., Davidson T., Hall-Craggs M.A., Payley M., Walmsley K., Cowley G., Taylor I. Comparison of magnetic resonance imaging and conventional triple assessment in locally recurrent breast cancer. Bri. J Surg. 1997; 84: 1147-51.
• 41)McCready DR, Fish EB, Hiraki GY, Ross TM, Wall JL, Lickley HL Total mastectomy is not always mandatory for the treatment of recurrent breast cancer after lumpectomy alone. Can J Surg. 1992; 35: 485-8.
• 42)Mullen EE, Deutsch M, Bloomer WD.. Salvage radiotherapy for local failures of lumpectomy and breast irradation. Radiother Oncol. 1997; 42: 25-9.